Cost-effectiveness of laparoscopic disease assessment in patients with newly diagnosed advanced ovarian cancer
To determine if laparoscopy is a cost-effective way to assess disease resectability in patients with newly diagnosed advanced ovarian cancer. A cost-effectiveness analysis from a health care payer perspective was performed comparing two strategies: (1) a standard evaluation strategy, where a convent...
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Published in | Gynecologic oncology Vol. 161; no. 1; pp. 56 - 62 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
01.04.2021
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Subjects | |
Online Access | Get full text |
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Summary: | To determine if laparoscopy is a cost-effective way to assess disease resectability in patients with newly diagnosed advanced ovarian cancer.
A cost-effectiveness analysis from a health care payer perspective was performed comparing two strategies: (1) a standard evaluation strategy, where a conventional approach to treatment planning was used to assign patients to either primary cytoreduction (PCS) or neoadjuvant chemotherapy with interval cytoreduction (NACT), and (2) a laparoscopy strategy, where patients considered candidates for PCS would undergo laparoscopy to triage between PCS or NACT based on the laparoscopy-predicted likelihood of complete gross resection. A microsimulation model was developed that included diagnostic work-up, surgical and adjuvant treatment, perioperative complications, and progression-free survival (PFS). Model parameters were derived from the literature and our published data. Effectiveness was defined in quality-adjusted PFS years. Results were tested with deterministic and probabilistic sensitivity analysis (PSA). The willingness-to-pay (WTP) threshold was set at $50,000 per year of quality-adjusted PFS.
The laparoscopy strategy led to additional costs (average additional cost $7034) but was also more effective (average 4.1 months of additional quality-adjusted PFS). The incremental cost-effectiveness ratio (ICER) of laparoscopy was $20,376 per additional year of quality-adjusted PFS. The laparoscopy strategy remained cost-effective even as the cost added by laparoscopy increased. The benefit of laparoscopy was influenced by mitigation of serious complications and their associated costs. The laparoscopy strategy was cost-effective across a range of WTP thresholds.
Performing laparoscopy is a cost-effective way to improve primary treatment planning for patients with untreated advanced ovarian cancer.
•Laparoscopy is a cost-effective way to assess disease resectability in patients with newly-diagnosed advanced ovarian cancer.•Laparoscopy was cost-effective even when varying model parameters, such as the cost added by performing laparoscopy.•Laparoscopy is a valuable tool to improve treatment selection in untreated patients with advanced ovarian cancer. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Formal analysis – RFH Validation – RFH, MV, SBC, CCS, LAM Project administration – AKS, SNW, NDF, LAM Writing - original draft – RFH Supervision – SBC, CCS, LAM Data curation – RFH, MV, CCS, NDF Resources – RFH, LAM, AKS, SNW, KHL Funding acquisition – AKS, KHL, LAM, SNW Visualization – RFH Writing - review & editing – RFH, SBC, CCS, MV, SNW, NDF, IT, AKS, KHL, LAM Conceptualization – RFH, SBC, CCS, AKS, NDF, SNW, LAM Software – RFH Methodology – RFH, SBC, CCS, LAM CRediT Investigation – RFH, SBC, CCS, MV, LAM |
ISSN: | 0090-8258 1095-6859 |
DOI: | 10.1016/j.ygyno.2021.01.024 |